Medplum provides an integration with Twilio to send and receive SMS messages directly from your healthcare application. Messages are stored as FHIR `Communication` resources, enabling seamless integration with your clinical workflows.

**Hosted Medplum Only**  
This integration is available on hosted Medplum only and requires setup by the Medplum team. It is not available for self-hosted deployments. [Contact us](mailto:info@medplum.com?subject=Twilio%20SMS%20Integration) to enable Twilio SMS for your project.

**Planning this integration?**  
The [Messaging & Communications Decision Guide](/content/docs/decision-guides/messaging/index.html) walks through requirements questions and FHIR modeling decisions for messaging — thread structure, routing, and external channels — use it alongside these docs.

## Overview  
The Twilio SMS integration allows you to:

- **Send outbound SMS** from FHIR `Communication` resources via the `$send-sms-twilio` operation
- **Receive inbound SMS** and store them as `Communication` resources via a Twilio webhook
- **Register inbound webhooks** for one or more Twilio phone numbers via `$twilio-sms-register-inbound`
- **Test connectivity** to verify your Twilio credentials via `$test-twilio-connection`

## Prerequisites  
- A Medplum project with the Twilio SMS integration enabled
- A Twilio account with at least one SMS-capable phone number
- Your Twilio Account SID and Auth Token

## Getting Started  
| Guide | Description |
| --- | --- |
| [Setup](/content/docs/integration/twilio-sms/setup/index.html) | Install the integration and configure your Twilio credentials |
| [Sending SMS](/content/docs/integration/twilio-sms/sending-sms/index.html) | Send outbound SMS via the `$send-sms-twilio` operation |
| [Receiving SMS](/content/docs/integration/twilio-sms/receiving-sms/index.html) | Receive inbound messages and track delivery status |
| [Threading](/content/docs/integration/twilio-sms/threading/index.html) | Organize messages into conversation threads |